Information for GPs impacted by bushfires


 

A variety of people may be directly or indirectly exposed to  fires and their reactions may range from acute distress to denial and disbelief. Such shocking experiences may have an immediate impact for some, leading to acute and ongoing severe distress. Others may experience a temporary shutting off of feelings, revealing little external response. There is no right or wrong way to respond. Making sure people are physically safe, listening and comforting them are basic responses for general practitioners.

Experiences range from those with the most direct exposure to the fires, to those with contact only through what they have seen on the media; both groups may be affected. Most people recover from such traumatic events but if distress continues people may need professional assessment, and possibly intervention. Those who seek help from a health professional will most often first present to a GP.
 


Distress, denial and disbelief are common reactions people may show for days and sometimes up to weeks after a bushfire. In the initial hours and days, people may be stunned and dazed, particularly in response to a sudden and devastating disaster.

The most important provisions in the first hours to the first weeks after a fire are safety, comfort and the support of family and/or friends.

GPs should ensure their patients impacted by bushfires are safe and have the support of family members, friends and the community.

During the  first consultation with a patient impacted by fire, GPs are advised to:

1. Listen, comfort and quietly accept information

  • Offer help and comfort.
  • Be quietly responsive. Touch, if appropriate.
  • Some people may be helped by talking, for others talking may make it more difficult or, it may not be the right time. Let the individual guide you.
  • Identify support systems of family, friends and local community groups.
  • Remember the special things in families that may be important, e.g. pets.

2. Ensure survival, safety and security

A stunned mental state can leave people relatively unaware of their own safety and vulnerability.

A brief medical assessment allows:

  • Assessment of physical injuries
  • A review of changes to pre-existing physical and mental health conditions
  • Time for contact and talk
  • Gives reassurance and shows interest. Provision of a safe place to stay is important. If very concerned about someone's mental health, talk to a mental health professional.

3. Orient towards goals

Trauma and grief can leave a sense of chaos and fear. Activities that can help patients regain a sense of structure include:

  • Basic routines (meals etc)
  • An early follow-up appointment at 1 month and again if concerns at 3 months
  • Being in the company of others until the acute distress/denial subsides (hours to days)
  • Show patients things they can do themselves towards recovery
  • Practical tasks and everyday routine are helpful.
 

The main issues for patients in your initial consultation are fear, grief and loss, and dislocation.

It is common to experience grief and trauma after a disaster.

Feeling dislocated from one’s home and environment, due to the loss of a house or neighbourhood, are factors that can lead to ongoing distress.

Common themes that patients might express are:

  • Difficulty falling and remaining asleep
  • Anxiety
  • Uncertainty about the future and what they can do to feel safe, supported and happy again
  • Disruption to normal routines and patterns of life adding to uncertainty
  • Irritability, anger and frustration can be common

There are ways to help people reengage with the practical aspects of their lives, including:

  • Linking to others such as family, friends and neighbours. This could be done directly, through social media, or any other channels that work best for them.
  • Getting the best sources of information, including local radio and newspapers, media and call centres.
  • Helping people call upon their own personal strengths that they have used in the past or in difficult situations (everyone has these). This is a very powerful part of getting better.


It is important to identify those at greater risk of problems in the early weeks, months, or over a longer time. These include groups with the following experiences:

  • Belief that they were about to die
  • Loss of a loved one
  • Pre-existing and chronic health problems
  • Lack of support systems or connections
  • Very severe or disabling injury
  • Exposure to multiple deaths or injuries of others
  • Pre-existing vulnerabilities including socio­economic disadvantage

Vulnerable groups may include Aboriginal and Torres Strait Islander people, refugees, children, the elderly and single parents


Specialist help may be needed after one month if a person:

  • Still feels upset, very teary, or fearful most of the time
  • Has changed behaviour compared to before the trauma
  • Can't function in normal activities
  • Has worsening relationship issues.
  • Is overusing or abusing substances
  • Feels jumpy or disturbed sleep
  • Is dwelling on the event
  • Is unable to enjoy life; numbness or withdrawal
  • Is experiencing overwhelming grief that prevents functioning,

General practitioners should feel confident to assess and refer on for specialist mental health treatment those patients with persisting symptoms that disrupt daily functioning after the disaster.

 
  • Major depression
  • Major anxiety disorders
  • Post traumatic stress disorder (PTSD)
  • Substance abuse
  • Major behavioural change
  • Psychosomatic complaints
  • Panic disorder

Note that these may co-occur with physical health problems and that both should be assessed and managed.

 
  • Withdrawn, quiet
  • Whiny, irritable, angry
  • Headaches, stomach aches
  • Regression to younger behaviours- thumb sucking, bedwetting, baby talk
  • Clinginess
  • Over reactions to minor hurts, physical and emotional
  • Behavioural problems
  • Acting out.

If a child is so acutely distressed and unable to function continuing beyond the first week then an assessment by a mental health professional is required.


Remember that doctors themselves may be directly impacted by fires and need to look after their own health and well-being. Doctors may also become overloaded by the traumatic experiences of others.
 
Early indicators that a doctor is affected by the traumatic experiences of their patients may include

  • Heightened response to the patient.
  • Increased levels of arousal (sleep disturbance)
  • Avoidance (includes increased alcohol use)
To avoid being overwhelmed, doctors should consider:
  • Discussing distressing or difficult experiences with colleagues
  • Limiting their exposure to a tolerable level
  • Maintaining good general health with regular exercise, good nutrition and sleep habits
  • Seeking help if needed

GP support program

If you have been impacted by a fire, please take care of your own health. Should you need support, don't hesitate to contact the RACGP.
 
The RACGP GP Support Program provides free and confidential psychological support to members.
 

Doctor’s Health Advisory Service

The Doctor’s Health Advisory Service provides confidential crisis and referral service 24 hours, /7 days a week.

Phone 

Australian Capital Territory 02 9437 6552
New South Wales 02 9437 6552
Northern Territory 08 8366 0250
Queensland 07 3833 4352
South Australia 08 8366 0250
Tasmania 03 9495 6011
Victoria 03 9495 6011
Western Australia 08 9321 3098
 

Web 

www.dhas.org.au 

 

CRANAplus Bush Support Service

CRANAplus’ Bush Support Services provides a free and confidential 24-hour/7-day-a-week telephone counselling service for rural and remote health practitioners. The service is staffed by psychologists, including two Aboriginal psychologists. CRANAplus membership is not required to access the service. Phone 1800 805 391.

 

Community support services

Other support services available to patients include:

Lifeline   

13 11 14

Kids helpline     

1800 551 800

Mensline

1300 789 978 

Suicide helpline

1300 651 251


Supporting communities that have been affected by fires can be a particularly difficult and distressing time for GPs. The RACGP has a range of resources available to support GPs and their communities:

External mental health resources are available to support community and self in the wake of traumatic events: